NATIONAL CENTRE FOR CELL SCIENCE, PUNE (An autonomous Institution of the Department of Biotechnology, Government of India) NCCS Complex, Pune University Campus, Ganeshkhind, Pune - 411007, Maharashtra, India.

APPLICATION FOR THE POST OF…………………. Note: - FILL UP ALL DETAILS IN BLOCK LETTERS. (Incomplete form will not be entertained)

01. Name (SURNAME- NAME -MIDDLE 06.I) NAME)Permanent Address along *Valid Affix latest 02. Name of Father/Spouse with City Pin Code No., Telephone/Mobilepassport 03. Advt.City/Village, No. , Applied District, Post State & Number(s):size Post& Country. Sr. No. photograp 06.II)04. DateCorrespondence of Birth Address h 05. Agealong as onwith (20.01.2015) City Pin Code No., City/Village, District, State & Country. 06.III) *Valid E-Mail Address: *Please make sure that the e-mail id & mobile number is correct and legible.

07. Gender: 08. Marital status:

09. Nationality: 10. Whether SC/ST/OBC/

10. A) For OBC –Specify Latest Non Creamy Layer Cert. validity date:

11. Additional Qualifying Examination(s) passed (A) CSIR/UGC- NET/LS (B) GATE/DBT-JRF (Category-II Fellowship) Registration/Roll No.: Registration/Roll No.: Date of exam: Date of exam: Valid till: Valid till: Year of Passing: Year of Passing:

12. Educational Qualification: (Starting from SSC onwards) Degree/ Name of the Subjects/Spe Total Marks Percent Month & Examination Board/Universi cialization Obtained/Ou age / Year of passed ty t of Grade passing

13. Experience: (Starting from the present/immediate last employer) Name of the organization, Period Scale of Pay & Reasons Post Held & reporting Nature of Gross for guide/head/in- charge Job Emoluments Leaving officer From To

14. Title of the Ph. D. thesis:

15. Research Publications with full references (if any):

16. I am herewith submitting my post preferences:

Posts Post Sr. No. Post Sr. No. Post Sr. No. Post Sr. No. Post Sr. No. 1st 2nd 3rd 4th 5th Preference Preference Preference Preference Preference RA/SRF (Strike out whichever is not applicable) JRF (Strike out whichever is not applicable)

RS-Research Scientist/RA-Research Associate / PDF-Post-Doctoral Fellow / SRF-Senior Research Fellow / JRF-Junior Research Fellow / PA-Project Assistant/ AA-Admin Assistant/RA-Research Assistant/PF-Project Fellow

DECLARATION

I hereby declare that I have carefully read the instructions and particulars supplied to me and that the entries made in this application form are correct to the best of my knowledge and belief.

Date: - Signature of the Candidate